Recommendations for New User

Hi. I have just been diagnosed with sleep apnea and I'm waiting for the results of the titration study and for the DME to call and set me up. At the sleep study, I ended up struggling with a nasal mask and ended up with nasal pillows. My AHI number is 37. At the study we used a standard machine that went from 0-20 (I think), so my pressure will be less than 20.

Besides being overwhelmed (but accepting) of the diagnosis, I'm overwhelmed with the different machines and what I should get. I don't even know if I get a choice. So for those seasoned veterens out there...what is the best machine out there. What bells and whistles should I ask for and what are not important. And here's my dumb question..I see a lot of talk about a heated humidifier. Is that in the machine or separate? And what are all the secrets that you wish you knew when you began. I have this sneaking suspicion the DME will give me a cheapo machine and I won't even know it!

Any help is appreciated. Thanks.

Hi DJinNewton,

Welcome to the forum and xPAP therapy. There are many on this forum that are much more qualified to (and will) answer your questions, but I will give you a few basics.

I don't even know if I get a choice.

If you search this forum you will very quickly begin to learn what you need to make the early decisions regarding your therapy. One of the first things you need to learn is that you are in total control - you absolutely have a choice. Your doctor will prescribe a machine, but you should be involved with him or her in the selection. Then when the prescription is written, YOU should make sure that the doctor has prescribed specifically what you want.

I'm overwhelmed with the different machines

A lot of the confusion is because there are many manufacturers and there are different machines for different conditions. Much of that will be resolved by your prescription. The doctor will determine if you need a 1) Straight CPAP machine, 2) Auto, 3) Bi-level or 4) ASV.

A personal bias: If your doc determines that you only need a straight CPAP machine, I think (and I'm fairly sure the majority of posters would agree) that you should try to persuade him/her to prescribe an AUTO (APAP) machine. They literally only cost a few dollars more and they provide you flexibility in the future management of your therapy. If you try, you may find resistance from the doc. If so, try to argue that the APAP can be set as CPAP and that you would PREFER to have the APAP! (You might want to insist -- remember you do have choices!)

There are other makes, but the two with which I am familiar are the (PR) Phillips Respironics and ResMed. Those two seem to be the most often prescribed. Others may be just as good, or even better, I'm just not familiar with them. Both are excellent machines. It's sort of the old Ford vs Chevy argument -- my personal preference is the ResMed, but you'll find a vocal group for the PR.

If you go with either the PR or ResMed, you should insist on the current model: PR System One or ResMed S9 series. The model should be specified in the prescription.

One of the first machine considerations with which you will need to become familiar is whether the machine records efficacy data, which will allow you to download the data to your computer and use software to monitor you therapy. Those that do not record efficacy data are "affectionately" known as BRICKS.

Respironics Machine: robysue's thread will give you a good basic understanding and the non-efficacy data machines to avoid . . .

viewtopic.php?f=1&t=72302

ResMed: Two non-efficacy machines that you absolutely should not accept are: S9 Escape and S9 Escape Auto.

I see a lot of talk about a heated humidifier. Is that in the machine or separate?

Both PR and ResMed have heated humidifiers, which are separate units. They can be sold without the humidifier, but in consult with you doc, ask for heated humidification. If you go with a ResMed ask the doctor to specify a ClimateLine Heated hose. The PR System One product line does not provide a heated hose, except for one recently introduced model: PR System One REMStar 60 Series Auto DS560TS.

I have this sneaking suspicion the DME will give me a cheapo machine and I won't even know it!

Rather than having a "suspicion," assume that to be a fact. You will probably read a lot (usually deserved) negative info about the DMEs. Keep in mind that they will provide you the least expensive machine that will fulfill the doctor's prescription. So, as indicated above, you need to have the doctor prescribe EXACTLY which machine and equipment you want.

what are all the secrets that you wish you knew when you began.

What I wish I had known was that I did have choices. I, as I'm sure many on this forum, accepted a prescription without question and took delivery of a machine that was totally unsuitable for me.

KNOW that you do not have to use ONE particular DME (for that matter ONE doc). If the DME hesitates or refuses to deliver what you want and expect, then find a different DME BEFORE accepting the equipment. Make sure the machine is a CURRENT model and NEW, with ZERO hours.

Give a lot of consideration to the mask you WANT. It will be your first (and possibly greatest) challenge. Try to learn enough about masks to make your best guess. If you know which mask you want, or with your best guess, ask the doc to put the specific mask on the prescription. Regardless, be aware that for the first 30 days, you should be able to switch masks, at no cost. Some DMEs may allow more than one exchange.

The fact that you posted your questions indicates that you have the right approach. Spend as much time as you can on this forum before seeing your DME. GET A COPY OF THE PRESCRIPTION before going to the DME. If it is not exactly what you want/expect, have the doctor change it. You'll be a lot better off delaying a couple of days to get what you want/need. The alternative of getting a replacement machine at a later day can be a nightmare!!

Best of luck with you therapy!

DJinNewton wrote:Besides being overwhelmed (but accepting) of the diagnosis, I'm overwhelmed with the different machines and what I should get.

Hi,

Welcome to our world.

It is OK to be overwhelmed. In fact, some folks actually go through a period of mourning almost as if a part of them has died. To complicate the issue, OSA messes with your brain chemistry and makes it harder to adapt. That will clear up once you start getting some good sleep. In my case, I was actually kind of relieved to get the diagnosis. I thought my sleep issues were the end of the world, and I was so happy to learn that there was something that could be done to make it better.

There is a lot to learn, but I think you will do OK since you are asking good questions. Please post back and keep us up to date on how it is going.

Good luck!

-john-

Welcome to the forum.

One of our forum member has an excellent blog with some information that will help you.
This one talks about full data machines...full data meaning much more than hours of use.
http://maskarrayed.wordpress.com/
and this one about what to know before your meet with a DME
http://maskarrayed.wordpress.com/what-y ... me-part-i/

Thanks for all the support. It is overwhelming but I agree it is a bit of a relief to know why I'm so tired all the time. I didn't even realize the process of having a doctor write a prescription. I've been dealing with the sleep lab and they say that I'll get a call from the company that will set me up. It would be nice is they explained the process better. I saw my primary care and he was surprised I hadn't seen the sleep doctor at all...nor had any plans too. The sleep lab never mentioned anything. He wants me to make an appt myself (which I'll do). I started surfing the net and found this great forum. what a great place for info on the process, machines, masks and understanding the system to get what you need. It's nice to feel like I have some power and not just a lemming following orders.

When you get a chance why not go ahead and register here at the forum...then you can send and receive private messages and when you get your equipment you can add it to your profile (that gets created when you register) like I have mine. Makes things go smoother if we can see at a glance what you are using if you have questions.

Whatever you do...don't accept a machine that doesn't offer full efficacy data. So make sure you know which models do what. When in doubt...come here and ask.

Just remember that you could be adding 20 to 30 years to your lifespan. You won't be getting up 4 time a night to go to the bathroom any more. You won't fall asleep driving. You will feel so much better in a few weeks (I felt better after day one) that you'll love your sleep. This is a wonderful technology! The only downside is that one you start, your body will not go back to sleeping without it. You won't have the hormones to help you get by with the lower c02 rats at night. Get a back up machine even if it's a cheap brick and a full face mask for when you have a bad cold and a back up battery in case you lose power. that's my advice.

my best wishes and welcome to you.

Good news. I just spoke to the DME and I'm getting the S9 Auto with the heated humidifier. I asked about the Climate Line Hose hopefully I will get that though it wasn't specific on the prescription. Besides the masks and replacement filters what does the insurance pay for and that I have to go through the DME? Do I have to purchase the software and do I just do that at cpap.com? and should i use sleepyhead or resmed? Do I just get a regular memory stick for the machine? I like to get what I need before they come to set me up. I'm at a loss about the software. But on the bright side I already bought distilled water! (formerly DJinNewton)

BostonGal wrote: Do I have to purchase the software and do I just do that at cpap.com? and should i use sleepyhead or resmed? Do I just get a regular memory stick for the machine? I like to get what I need before they come to set me up. I'm at a loss about the software. But on the bright side I already bought distilled water!

No need to purchase the software. DME wouldn't give it to you anyway.
UncleBob has ResScan in his signature. memberlist.php?mode=viewprofile&u=38643

There is a tutorial also you should watch. http://montfordhouse.com/cpap/resscan_tutorial/

SleepyHead...links to its important stuff are in my signature here. Be sure to read the user guide and the glossary so that the terms you see on the reports don't look like a foreign language.

The machines normally come with a SD card you don't need anything else unless your computer doesn't have a slot for the SD card. They are easy to find to ..Walmart has them for around $10 and some come with an extra SD card. It's a card reader/adapter..one end goes into the USB port on your computer and the SD card slides into the other end.

Here are my recommendations. Ive been using CPAP/APAP and now BIPAP for about five years now. I got off to a really good start and I attribute it to the fact I got titrated well the first time and got a good brick and mortar DME the first time. Now, prefer Internet supply companies like this company. Less hassle. Here are my recommendations for a CPAP newb:

1) start off with a nasal mask. They are the most comfortable and easiest to fit. I personally think Resmed makes the best masks. It is critical to get fitted properly for ALL masks, whether nasal or full face mask

2) If during the first several days to a week of using the nasal mask, your mouth dries out and you wake up repeatedly with air coming out of your mouth, you have a mouth leak problem (common) and the best solution for mouth leak is a full face mask. A lot of people give up at this stage, but persistence with a good full face mask will give you good results. I recommend the Resmed Mirage Quattro. Maybe the Quattro FX if your pressures are not high. That is, IF you need a FFM. Hopefully you will not be a mouth breather/leaker and can get by with a nasal mask (lucky you)

My opinion is the Resmed Mirage Quattro is the single best full face mask on the market. It handles high pressures well, it handles jaw drop the best. It is not the most comfortable mask, but it will salvage your CPAP therapy if you are a mouth leaker.

One you find a mask that works well for you, stick with it. Dont change around. If your DME is good, it should not take more than a wee or two to find the proper mask. They should be able to tell you within a week, two at most, if you need to try a full face mask. If you are waking up with dry mouth daily and waking up with air coming out of your mouth or starting to feel even more tired, and your DME does not recommend a full face mask, they probably are not any good. Some will push nasal mask combos with chin straps. Chin straps work for some, but for serious mouth leak, you gotta face up to it and get a full face mask.


3) if at all possible, get referred to a DME that specializes in respiratory equipment only. There are a few out there. Most are generalist DMEs. I got started off with a respiratory therapy equipment ONLY DME and that made a huge difference in me getting off to a good start.

4) There is nothing at all wrong with straight CPAP. I would get one that is data compatible. You want one that you can do downloads with and see your daily and average AHIs, leak rate, etc. Also, a straight pressure (plain old CPAP) is the easiest for a lot of newbies to adjust to, especially if your pressure is not high.

5) If your titrated pressure is high (above 10) or if you drink at night or take a lot of sedative medications or your weight fluctuates frequently, probably ask for an APAP. You can run APAPs in CPAP mode and if needed, switch over to APAP mode. Or just run it in APAP mode.

6) After experiencing both CPAP and APAP for years now, I now am of the opinion that a straight pressure gives the best clinical effect, but also has the most side effects. Especially with high pressures.

7) Once you learn the ins and outs of CPAP/APAP, using Internet Supply companies has been the least stressful for me. I still use insurance and brick and mortar DMEs for some stuff, like today I got a new BIPAP and got little hassle. But a lot of the time I get beaucoup hassles from insurance and brick and mortar DMEs and overall, find it easier to just pay out of pocket and deal direct with Internet supply outfits.

Lose weight if you need to, losing weight works for OSA.

Tonight is my first nite. Wish me luck.

I went to Uncle Bob's profile and see how to download the software but it asks for me to register. Is that what it's supposed to do? Just wondering if I need to register with ResMed ResScan Register to get the software.

Thanks.

BostonGal wrote: I went to Uncle Bob's profile and see how to download the software but it asks for me to register. Is that what it's supposed to do? Just wondering if I need to register with ResMed ResScan Register to get the software.

The registering at the ResMed site and the checked box for use under a physician are just formalities.
They don't check anything and they don't send you an email and no cpap police will come to your door.
MickyMouse who lives at DisneyLand with a fantasy email address was able to download the software.
So just fill in the blanks with something...there is no registering requirement past that screen.

The CPAP Shop is selling the DS560TS for 649 and if you shop hard enough, you might save a few more dollars. My Sleep Doctor's co-located DME was refused to buy an auto. I did convince Doc to write an Auto RX and just ordered the darn thing myself.

Looks like Respironics is trying to take market share away from the Resmed S9 series on all System Ones are being discounted 300 to 400 under the S9 autos. Either the series stinks or they really want market share from Remed.

Anyhow, I read that both are about equal with many pros on both and each with minor cons. I did choose the DS560TS over the Resmed S9 with Humidifier and heated tube simply due to the much lower price.

If you can afford it, forget the hassle of dealing with the DME on the machine. Or, just use a DME for resupply. Most will still support resupply for machine and masks even if you buy your own machine and bill insurance for the resupply only.